Hans D. posted an article on A Country Doctor Writes: - Feb 4, 2012, 7:29 am
“Make every day your masterpiece.”              Coach John Wooden “…to do the day’s work well and not to bother about tomorrow. You may say that is not a satisfactory ideal. It is; and there is not one which the student can carry with him into practice with greater effect. To it ...
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Hans D. posted an article on A Country Doctor Writes: - Jan 29, 2012, 8:26 pm
Last week I saw several older patients who were fretting about their mildly reduced kidney function. All of them were women in remarkable health, but each one had at one time or another had a brush with hospital medicine: Mrs. Allard had a mastectomy five years ago, Mrs. Perlman had an episode of c...
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Hans D. posted an article on A Country Doctor Writes: - Jan 22, 2012, 4:43 pm
My eyes played a trick on me the other night, or perhaps it was my subconscious. Emma and I were reading by the fire – my nose was in one of my medical journals and she had a stack of animal behavior books next to her while looking intently at the screen of her laptop computer. As I was reading a...
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Hans D. posted an article on A Country Doctor Writes: - Oct 25, 2011, 6:27 pm
“Elsa Bruegger has seemed a little unsteady in the morning lately”, the charge nurse told me at my boarding home rounds two weeks ago. “Her morning blood sugars have been a little low. Do you think we should cut back on her insulin?” “Sounds reasonable”, I answered. Let me look at her c...
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Hans D. posted an article on A Country Doctor Writes: - Oct 15, 2011, 8:58 pm
A hard frost had claimed the white Geraniums in the flower boxes on the south side of the little red farmhouse a week earlier. Then Columbus Day weekend brought bright sun and the gift of summer temperatures again. His family brought him outside around noon and placed him carefully near the east-fa...
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Hans D. posted an article on A Country Doctor Writes: - Aug 27, 2011, 8:16 pm
              “Let food be thy medicine and medicine be thy food.”                                                                                        Hippocrates “I saw few die of hunger; of eating, a hundred thousand.”         �...
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Hans D. posted an article on A Country Doctor Writes: - Aug 25, 2011, 8:20 pm
Last weekend I sat down to look at some of the journals I receive at home in the mail. A couple of articles caught my interest, all touching on how we use the medical record. Dr. Aldebra Schroll describes in an article in Medical Economics how her meticulous medical records were used to deny her pa...
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Hans D. posted an article on A Country Doctor Writes: - Aug 14, 2011, 6:04 pm
Hitting machine with hammer:         1.00 Knowing where to hit machine:    999.00 Total:                                      1,000.00 There are many versions of the story with this punch line. One is about a plumber, another about Thomas Edison and...
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Hans D. posted an article on A Country Doctor Writes: - Aug 6, 2011, 7:56 pm
In February 1995 I must have seemed overworked and headed for burnout. Clarine, my bed-bound patient who always encouraged me to write down my thoughts and experiences as a country doctor, gave me a copy of Thomas Moore’s 1992 bestseller “Care of the Soul”. She ran a small book editing and pub...
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Hans D. posted an article on A Country Doctor Writes: - Jul 24, 2011, 7:25 pm
“The conflict between evidence-based medicine and individuals is at the core of the struggle to reduce the cost of care.  I fear it is intractable and will remain so… We need to talk about the tensions and uncertainty, with respect for each other and with open minds. I’m not sure what solutio...
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Hans D. posted an article on A Country Doctor Writes: - Jul 16, 2011, 7:16 pm
  “Joel, let’s not kid ourselves. Whatever we diagnose, most patients, if they don’t die, get well by themselves. Our job is mainly to try to make them feel better. Do no harm.”   Leonard Quinhagak, the Healer (Northern Exposure) I never enjoyed covering for Dr. Ferguson. She was a ni...
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Hans D. posted an article on A Country Doctor Writes: - Jul 14, 2011, 7:36 pm
The last time I rented a car at the Stockholm airport, I felt a little nervous filling up the gas tank. The brand new Volvo was a flex-fuel car and the Swedish gas pumps had more choices than I was used to. After fretting about it for a few moments, I still chose the familiar unleaded gasoline over ...
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Hans D. posted an article on A Country Doctor Writes: - Jul 9, 2011, 6:51 pm
There were two “suits” and several boxes of free pizza in the lunchroom when I stopped in to grab some coffee the other day. The enthusiastic young drug “rep” spoke rapidly while our staff ate. His regional manager watched and listened. Drug “reps” are the only people you ever see in a ...
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Hans D. posted an article on A Country Doctor Writes: - Jul 3, 2011, 6:55 pm
“So when did you get hooked on opiates?” I asked matter-of-factly. The young man’s low-hanging black jeans were frayed at the bottom. He wore a black hooded sweatshirt – lightweight, but still out of place in the hot weather. His earlobes were pierced and stretched out with black hollow cyl...
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Hans D. posted an article on A Country Doctor Writes: - Jun 18, 2011, 7:06 pm
Dear Patient, You and I have been working together for many years now, and we have had both triumphs and disappointments. You have looked to me for guidance and advice about many different medical issues, and sometimes also about life’s other challenges. I hope I have been helpful most of the ti...
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Hans D. posted an article on A Country Doctor Writes: - Jun 4, 2011, 4:16 pm
“Burnout skills are the actions at which you excel, that people identify as your strong points but which drain you of motivation. They are unable to energise you and therefore deplete you without refueling you.”                                                        ...
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Hans D. posted an article on A Country Doctor Writes: - May 29, 2011, 7:06 pm
I had seen Eldon Beauford almost every week for the last six months to monitor his congestive heart failure. Every time his weight went up, I temporarily increased his diuretics, and every time his heart rate was faster or slower than ideal, I adjusted the medications we used to rate-control his atr...
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Hans D. posted an article on A Country Doctor Writes: - May 27, 2011, 7:01 pm
Lester Croppe never did come back for his follow-up two months ago. He did show up this week, however, with a big frown on his perpetually tanned, furrowed face. I immediately got the sense that Lester was upset or unhappy, although I wasn’t sure why. “It’s been a while”, I said tentativel...
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Hans D. posted an article on A Country Doctor Writes: - May 24, 2011, 7:52 pm
I have known for several months that things were coming to an end between Helen and myself, and that I would probably have to be the one to actually end our relationship. Helen’s medical condition is quite ordinary, but her reaction to it is unusual. She is convinced that she has some dreadful, y...
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Hans D. posted an article on A Country Doctor Writes: - May 22, 2011, 4:43 pm
This time of year the snowbirds return from their winter retreats in condominiums, trailer parks, relatives’ homes and motels far south of here – in Florida, Arizona, the Carolinas and other, warmer locales. I have had many serious requests from patients to relocate with them to Florida for the...
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Hans D. posted an article on A Country Doctor Writes: - May 15, 2011, 4:02 pm
My middle-aged patient had all the risk factors for a heart attack: high blood pressure, borderline diabetes, high cholesterol, a strong family history and a sixty pack-year smoking habit. His stress test was positive and the medications that were started in the hospital weren’t controlling his c...
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Hans D. posted an article on A Country Doctor Writes: - May 5, 2011, 7:09 pm
Doug Leland is no stranger to back pain. After two failed back surgeries he is on long-acting narcotics in addition to high doses of seizure medications to dull the relentless nerve pain that burns day and night like an eternal fire deep inside his left leg. A few weeks ago Doug went to the emergen...
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Hans D. posted an article on A Country Doctor Writes: - Apr 30, 2011, 6:15 pm
Our clinic has an advanced computer scheduling system. It gives overviews of available appointments, makes statistical reports and shows several providers’ schedules in one view. But it can’t even begin to compare with Doreen and her paper and pencil system. Doreen was our master scheduler more...
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Hans D. posted an article on A Country Doctor Writes: - Apr 16, 2011, 7:28 pm
“Tell me about the day you passed out,” I asked the middle-aged woman in Room 4 the other morning. “How did you feel?” “We were up early, my husband and I, because Debbie – that’s our daughter – was coming home for Easter break. She’s on the dean’s list at Swartham College. She ...
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Hans D. posted an article on A Country Doctor Writes: - Apr 8, 2011, 4:23 pm
“The young man knows the rules, but the old man knows the exceptions.” Oliver Wendell Holmes, Sr., M.D. I have been reading from two e-books lately on my new iPad. One of them, a bestseller published in 2005, is “Blink”, subtitled “The Power of Thinking Without Thinking” by Malcolm Gla...
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Hans D. posted an article on A Country Doctor Writes: - Apr 3, 2011, 3:51 pm
Talking with my wife on the phone at lunch today, I asked in my usual manner: “Was there anything interesting in the mail?” She hesitated for a moment before answering: “There’s a letter from the Board of Medicine.” My mind switched into a higher gear. “A letter? Not a mass mailing?...
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Hans D. posted an article on A Country Doctor Writes: - Mar 31, 2011, 8:03 pm
Edgar Bowler relies on his much younger wife, who sees one of my partners, to help him keep track of his appointments and drive him to the office. Both of them have multiple medical problems and between them they take well over a dozen different medications. She usually handles their prescription re...
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Hans D. posted an article on A Country Doctor Writes: - Mar 30, 2011, 7:33 pm
Sally Straub is the only lawyer in town. Her father was the town lawyer before her. He went on to become a judge. Retired from the bench, sharp as ever at 78, he is still “of counsel” with his daughter’s law practice. Sally is a sympathetic, no-nonsense woman with a big heart in a petite body...
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Hans D. posted an article on A Country Doctor Writes: - Mar 27, 2011, 4:38 pm
Cora Mills had never been treated for asthma before, but when I saw her this winter with a sinus infection and a tight sounding cough, she was wheezing terribly. Her oxygen saturation was fine but her peak flow was in the low normal range. She refused the steroid pills I wanted her to take along wit...
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Hans D. posted an article on A Country Doctor Writes: - Mar 26, 2011, 4:46 pm
“My name is DeWitt. I’m a neurosurgeon in Charleston, South Carolina,” a velvety male voice announced. I cocked the telephone receiver under my chin as I grabbed the chart Autumn handed to me. “I have just operated on your patient, George Magnusson. He had a large subdural hematoma from a f...
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Hans D. posted an article on A Country Doctor Writes: - Mar 15, 2011, 7:26 am
The band members brought their instruments and their small amplifier system into the activity room through the big glass doors facing the parking lot. As they tuned their instruments and warmed up, the residents started to stream into the big, bare room. Some arrived in their hospital beds, some we...
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Hans D. posted an article on A Country Doctor Writes: - Mar 6, 2011, 4:44 pm
Lester Burr was alone in the office Friday afternoon. Doris had dropped him off to go to the hairdresser. His diabetes visit went smoothly; he had normal blood pressure, cholesterol, kidney function and foot exam. His eye doctor report was up to date and none of his medications needed to be renewed....
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Hans D. posted an article on A Country Doctor Writes: - Feb 28, 2011, 8:54 pm
Early in my career I met Fran Dennison. She was a forty-something smoker with asthma and mildly elevated blood pressure. She seemed to always be under stress. A nontraditional university student, she was always trying to be in two places at the same time. After several visits with elevated blood pr...
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Hans D. posted an article on A Country Doctor Writes: - Feb 27, 2011, 5:08 pm
Rodney Grussman is a mild-mannered, unassuming seventy-year-old man with diabetes, emphysema and valvular heart disease. I see him every three months to monitor his bloodwork and his symptoms. He sees his pulmonologist about twice a year and has a couple of nodules in his right lung Dr. Welch is fol...
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Hans D. posted an article on A Country Doctor Writes: - Feb 19, 2011, 12:28 pm
When Joel Mulholland fell off his garage roof last winter he must have hit every bone in his upper body. The muscular, tattoo-armed, motorcycle-riding fifty-five-year old, who had never complained of pain or even taken a sick day before, became almost unable to work. His x-rays at the emergency roo...
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Hans D. posted an article on A Country Doctor Writes: - Feb 12, 2011, 4:18 pm
My new patient leaned back in the exam room chair and fixed his eyes on me. “I don’t need a doctor to tell me that I need a bunch of tests or medications. I know that if I lost weight and ate better I might live longer.” He paused as if to measure my reaction before continuing: “I know my ...
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Hans D. posted an article on A Country Doctor Writes: - Feb 3, 2011, 7:37 am
My new nursing home admit greeted me with his fist raised as I made my way down the corridor to the nurses’ station. His eyes locked onto mine and he waved his fist in the air while hollering: “Twenty-two! Twenty-two!” I had no idea what he was trying to tell me. I stopped and laid my hand o...
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Hans D. posted an article on A Country Doctor Writes: - Jan 23, 2011, 5:01 pm
Edna Lavoie has had horrendous blood pressure readings for several decades, but she has never had a stroke or heart attack. Her eye doctor swears her retinae are healthy. Whenever she takes a pill that even begins to normalize her blood pressure, she complains of severe dizziness. Dwayne Lieber’s...
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Hans D. posted an article on A Country Doctor Writes: - Jan 13, 2011, 6:31 pm
I, like most primary care physicians, have many patients on chronic “blood thinners”. Warfarin, essentially the same chemical as rat poison, is the most common drug we use, and it can be difficult to manage. Because its effects are counteracted by vitamin K, simple dietary changes like eating fe...
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Hans D. posted an article on A Country Doctor Writes: - Jan 10, 2011, 10:08 pm
One of the movies we watched this holiday season turned out to be a wonderfully relevant commentary on medicine in 1947, and also today. In “Welcome Stranger”, Bing Crosby plays Dr. Jim Pearson, an easy-going, rootless Californian, who takes a locum tenens position covering for Dr. Joseph McRor...
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Hans D. posted an article on A Country Doctor Writes: - Jan 8, 2011, 5:51 pm
Mrs. Blouin was new to our practice. Her previous doctor, in the next town up the road, had left the area just over a year ago. Her presenting complaint was “Wants Reclast infusion”. Reclast is a once-yearly $1,200 intravenous infusion for osteoporosis, primarily for patients who cannot tolerat...
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Hans D. posted an article on A Country Doctor Writes: - Jan 2, 2011, 9:38 pm
“It appears to me a most excellent thing for the physician to cultivate Prognosis: for by foreseeing and foretelling … the present, the past and the future, he will be more readily believed to be acquainted with the circumstances of the sick; so that men will have confidence to intrust themselve...
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Hans D. posted an article on A Country Doctor Writes: - Dec 25, 2010, 6:02 am
I never did get my haircut for Christmas. The past few weeks, things seemed to be going at warp speed. Yesterday, my half-day at the office dragged on past two o’clock, and then there were two admissions, two 60-day reviews and several sick visits at the nursing home to take care of. The week was...
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Hans D. posted an article on A Country Doctor Writes: - Dec 16, 2010, 7:35 am
B. C. and his wife came in for his diabetes follow-up the other day. His blood pressure and blood sugar have been out of control for over six months now, but he has refused to try new blood pressure medications and he won’t consider insulin. He even hates pricking his fingers, so he had ordered a ...
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Hans D. posted an article on A Country Doctor Writes: - Dec 6, 2010, 6:39 pm
Mrs. Rizzo called the other day to ask if it was all right if she had half a glass of wine with dinner around the Holidays. This time I knew enough to say no. A year ago I didn’t know her very well and made the mistake of leaving a vague answer via Autumn, my nurse, amounting to ‘Probably’. ...
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Hans D. posted an article on A Country Doctor Writes: - Nov 25, 2010, 3:40 pm
There was a time when patients knew their doctor, but knew little about their medication until their physician chose it, prescribed it and explained its purpose. Today, in many cases, it’s the other way around. Doctors come and go and many patients have stronger relationships with their prescript...
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Hans D. posted an article on A Country Doctor Writes: - Nov 20, 2010, 8:36 pm
One of the first challenges I faced as a foreign doctor from an urban background practicing in a small town in this country was finding the right way to explain medical issues to my male patients. They were farmers and fishermen without much experience with illness, medications or medical procedures...
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Hans D. posted an article on A Country Doctor Writes: - Nov 19, 2010, 7:16 am
We have a joke at the clinic that the only type of paper that doesn’t need a doctor’s signature is the toilet paper. We are constantly scribbling our abbreviated signatures on incoming x-ray reports, specialist’s consultation reports, ER reports and lab results. Once signed, these papers get f...
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Hans D. posted an article on A Country Doctor Writes: - Nov 12, 2010, 7:24 am
Autumn, my nurse, called about 7:30 last night. Her five-year-old son, Curtis, had just come running into her kitchen from his bedroom, crying “Mommy, Mommy, I’m going to die!” “Why, Curtis?” she had asked. “I swallowed a screw”, he sobbed. Autumn tried to get him to describe the si...
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Hans D. posted an article on A Country Doctor Writes: - Nov 5, 2010, 6:43 am
Skip Rollins drove 35 miles to see me today for his blood pressure follow-up. A few months ago I had prescribed a mild diuretic, hydrochlorothiazide. I had ordered a blood test to be done a while after he started taking it in order to check on his potassium level and kidney function. Then I saw him ...
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